Job: Reimbursement Specialist II - Full time - Benefits Eligible

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Job Description

Reimbursement Specialist II

Job Category:
Administrative / Clerical

Patient Financial Services

Copley Drive - Kearny Mesa

Full time - Benefits Eligible



Req Number:

Job Details:


Under the direction of PFS Leadership, the Reimbursement Specialist II is responsible for billing and collections of outstanding account balances for commercial, government, and managed care payors as assigned. The Reimbursement Specialist II is required to identify and report payor issues to their leadership. It is a requirement for the Reimbursement Specialist II to read, interpret and apply complex payor contract language to expected reimbursement calculations and pursue all payments due to the organization. The Reimbursement Specialist II must perform account collection activities utilizing internet resources and professional telephone communication etiquette. The Reimbursement Specialist II is required to compose professional written correspondence with all internal and external entities. This position expects the Reimbursement Specialist II to demonstrate organization and time management skills to manage account collections. The Reimbursement Specialist II identifies payer trends in regards to denials/underpayments and makes appropriate recommendations. Works with payers to resolve denial and underpayment trends. Has a thorough knowledge of the revenue cycle and able to identify process problems impacting AR. Incumbent has a thorough knowledge of industry and payer billing requirements to include claim form requirements and revenue codes. Uses appropriate resources for investigation of denials to include payer guidelines and the UB editor.


High School Diploma, GED, or foreign equivalent

5 years of experience

Proficient in determining appropriate appeals or adjustments based upon analysis of the denial codes, charges, revenue codes, CPT codes, HCPCS codes, & ICD-9 (10) diagnosis/procedure codes.

Proficient in Microsoft Excel, Word and Outlook programs


Associate's Degree

Certification as an HFMA Credentialed Revenue Cycle Representative